Book Review and Philosophical Musings: David Karp’s Is It Me or My Meds?

Are you having a love affair with your meds? Or do they represent a Faustian bargain?

I’m reading a fascinating book right now by David Karp, the author of The Burden of Sympathy, which I already gave a highly positive review in this space. Is It Me or My Meds? asks the title question. As you will know if you take psychotropic meds, the answer is far from simple. Though the book focuses on antidepressants, Karp interviewed several people with bipolar disorder, and their concerns are well-represented.

The chapter that interests me the most so far concerns the existential problems presented by taking psych meds. To wit, “Am I a different person on my meds? If so, do I prefer the person I’ve become?” Initially, I believed that my answer is a simple “yes.” I would almost certainly be dead without antidepressants, and unlike many of Karp’s subjects, I’ve never felt that I was a better and more profound person without them. Yes, I may have led a more poetic existence in the shallow sense of brooding and scribbling at odd hours, but if I hadn’t found medication, I could not have lived to write.

No, I embraced medication from the moment I got my first diagnosis (anxiety disorder, with the attendant antianxiolytics) to my bouts of what appeared to be major depression, complete with a raft of antidepressants, to my doctors’ recognition that I’ve had a good deal of hypomania, and am bipolar II. I’ve refused drugs at times, and self-titrated on numerous occasions (who hasn’t?), but I’ve never been without medication since that first diagnosis, and the idea of trying to go it alone frankly panics me.

Granted, I’ve never experienced the side effects most likely to alienate you from yourself: emotional blunting, extreme weight gain, and loss of sexual desire. This has made it easier to love my meds. Medication does remove me from my emotions just slightly, but I experience this distance as a gift: it allows me to make decisions about how I will react to my feelings, whether I will lash out in anger or initiate a discussion, whether I will sob uncontrollably or leave a situation that causes me pain.

I have endured side effects that could potentially influence my sense of self. I consistently lose a good deal of weight on SSRIs, for example. Slender as I am, that’s not a good thing. Rather than sporting a lovely, slim new me, I look like a cancer patient or a serious, successful anorexic. This has caused me untold grief, from being threatened with a feeding tube to being confined to a residential treatment program for people with eating disorders. (My shrink at the time nursed the bizarre hope that the staff would be able to cure my nausea rather than simply threaten and bully me.) I’ve always been quite thin, though — I experience the weight loss as an unpleasant intensification of who I am, but it doesn’t fundamentally change either how I perceive myself or how others react to me. On one occasion it did briefly affect my very strong sense of myself as a profoundly, joyously sexual being. For the most part, though, I’m the same person at 92 as I am at 99 (my “normal” weight).

I’ve also suffered from very damaging cognitive problems that challenged my sense of myself as brilliant and articulate, but I now suspect that that’s the disease, not the drugs. Years ago I began refusing mood stabilizers because I believed that they stripped away memory and some executive function. Now the research I’ve read suggests the more eerie possibility that the disease causes these, and that if I responded to lithium (I don’t) then it might actually have neuroprotective effects. Over the years I’ve learned to refuse drugs that I know make me miserable, and I’ve accepted that I will never be the woman I was before I began my bipolar career. That last was a deep and terrible loss, on a par with my decision not to have children, but it hasn’t shaken my core identity as much as I would have thought.

Despite all of this, my attitude towards my medications remains ambivalent at the core for several reasons. For one thing, the more closely I examine the drugs’ effects on my life, the more difficult I find it to separate the drugs from the illness they are supposedly curing. I’ve had significant, even near-catatonic depression while medicated to the gills.

Also, as so many of Karp’s interviewees report, a drug can work beautifully for nine months or a year, then fail within a week. The violent disappointment that follows amounts to a sense of betrayal. When this happens, the drug that saved me becomes the enemy, a bundle of side effects with no benefits, even a danger. Everything that I thought was secure — my relationships, my job, even my will to live — begins to melt and break up like a torrent once confined by ice. Each time, the disruption and terror shake my very sense of whether my life is worth living and whether I will ever be able to maintain anything, from a home to a circle of friends, a loving relationship to family life to the capacity to work. As I begin to lose my grip on myself, I fear losing whatever life I’ve managed to build since the last time a drug left off working.

And, too, a drug can work only partially, leading me to think that antidepressants in particular can resemble a threadbare lucky shirt: if you have a terrible car accident while wearing it, instead of tossing the stupid thing out, you think to yourself, Imagine how horrible things would have been if I hadn’t been wearing it. As Karp points out, however, medications that offer negligible benefits can make patients suspect that they might be better off without them.

Conversely, successful drug therapy can lead to the seductive thought that perhaps I’m not so very ill after all. Hell, maybe I’m not even bipolar. After all, I feel so normal, so calm, reflective and satisfied with my life. In these periods, I’m tempted, as many of Karp’s subject are, to try to taper off and quit medication entirely. I never have, but the thought is there — at least until the drug begins to fail, depression breaks through, and I’m brutally reminded that I am not even remotely normal.

In the end, my attitude towards my medication might be described as loving and hopeful despite countless disappointments. I believe that, on and off, medication has significantly improved my quality of life, and has probably made it possible for me to work and to get an advanced degree. I am Buddhist in one sense (and in one sense only): I believe that life is pain, and my expectations for it are low. I am sure that my non-bipolar readers will testify that their lives are not composed of unalloyed joy. In addition, I believe, along with many researchers, that psychotropic drugs address only a small part of the various chemical and social factors that cause bipolar disorder, and therefore can offer only partial relief. Wellness, including exercise, a healthy diet, therapy, and art, can ameliorate the remaining pain, but tragedy, toxic boredom, loneliness and existential angst persist despite our best efforts.

That’s a low note to end on. Let me close, then, by saying that medication has brought me significant relief, and that a new medication to try still excites me as much as Christmas did my five-year-old self. In that, I am luckier than most of Karp’s subjects.

In closing, though I’ve spent little time specifically discussing Karp’s book, I recommend it highly for anyone who uses antidepressants, or who is considering using them. It gives a much more complete picture of the dilemmas and benefits of taking psychotropic medication than any doctor will, and curiously, though many patients’ remission may be partial at best, Is It Me or My Meds? does offer a certain hope.

Revolt and Resignation

In his collection of essays On Aging, Holocaust survivor Jean Amery said that one must meet the phenomenon of aging -- inevitable yet terrifying -- with both revolt and resignation. So it is with mental illness. To deny that I will always be manic-depressive would be true madness; at the same time, I must revolt against my condition, rejecting the idea that it defines and limits me.